Overweight Children

by T. Berry Brazelton, M.D., author of Feeding: The Brazelton Way

Americans are facing an epidemic of overweight children today—an estimated 20 percent of all children are obese. A child is considered obese if she is 20 percent above her normal weight for height and age. Obesity can also be defined as weight levels that put well-being and health at risk.

Overweight children suffer from being teased and from the resulting poor self-esteem. They may also avoid or have trouble succeeding in sports. This condition can also lead to medical problems in childhood (high blood pressure and cholesterol, sleep apnea, and joint problems, among others). It also can increase the risk of these and other disorders in adulthood (for example, cancer, diabetes, and heart disease). Childhood obesity is a major risk factor for obesity in adulthood.

Genetics plays a role in obesity, so any child with overweight parents is at risk. But in our country, children are also put at risk by fast foods and processed foods, full of unhealthy fats, sugars, and salt in oversized portions, nutritionally "empty" calories that don't supply a balance of necessary nutrients. Healthier foods, with more fiber and protein, are not the ones being pushed in television advertisements and fast food joints, and they may be more expensive. Sadly, our country's poorest children are most at risk.

Added to our unhealthy diet is our couch potato culture. Television, video and computer games, and the Internet take time away from physical activity. As fields and forests are taken over by malls and unsafe housing developments, and child-safe sidewalks are replaced by freeways, more children are kept indoors, in front of the TV.

For some children, there may be additional factors in weight gain. Some children may turn to food for comfort and soothing, particularly if they never learned other ways of comforting themselves. Some children may never have learned to pay attention to hunger and fullness cues. We'd expect this to be more common in children who never learn to enjoy sitting down for relaxed mealtimes with their families, but instead have meals in front of the TV and snack and graze all day. Children are more likely to learn to handle their appetites when mealtimes (and snacks) occur at regular, predictable times that have a beginning, middle, and end—such as salad to start with, then the main course, and finally dessert. If you are concerned about your child's weight, let your pediatrician know—early. In any case, your pediatrician should be monitoring your child's growth (weight and height) at each routine preventive visit. Overweight children under 2 years of age are likely to be obese later, as older children. Uncommon medical causes of weight gain, including hormone abnormalities, need to be considered. Depression can also lead to excess weight gain.

Many children gain a little weight just before entering puberty. Unless the gain is excessive, it should not be cause for concern. Children this age are often very sensitive about their appearance, and a parent's reaction to bodily changes can be very upsetting. Don't comment on it. If you are concerned, discretely ask for your pediatrician's advice at your child's routine visit. If your child is concerned, listen to her, let her know that you understand that it bothers her, but let her know that this is a normal change and that you are not worried.

What to Do When a Child Truly Is Overweight

After age 2 or 3, you can switch from whole milk products to low-fat ones. Skip fried foods. Substitute lower-fat sources of protein such as chicken, fish, and beans for red meat when you can. But even low-fat foods can have lots of calories—in the form of sugars and carbohydrates—and cause weight gain. (Examples are juices, sugary cereals, and candy.) Switch from juice—especially bottled juices high in sugar, and calories—to water. Fresh fruits and vegetables, which are high in fiber and vitamins, are healthier for overweight children than many processed or packaged foods. Whole grain breads and pasta, brown rice, and similar foods are an improvement over foods containing refined flour.

Weight gain is inevitable when the amount of calories a child eats is greater than the amount she burns off. Attention to an overweight child's diet must be balanced by an increase in physical activity. Walk or ride a bike (always wear helmets) with your child instead of driving to school or to do errands whenever possible. Have your child help out with physical chores around the house and garden. Encourage her to participate in school and after-school sports or dancing, although you may need to work with her to help her learn basic skills that she may have missed out on if she's been hiding from sports. Be sure none of this becomes a burden or a struggle. Let her participate in choosing her favorite fitness activity. The focus should be on health, not appearance. Try to make all of this as matter-of-fact as possible, or still better, fun!

Your child won't be interested if she feels hurt by any suggestion from you that she is overweight. Instead of starting with your concerns, listen to her—children at school tease her, she can't run as fast as she wants, she's embarrassed by having to wear "husky-size" clothes, and so on. When she comes to you with concerns like these, don't tell her that she's overweight. Instead ask her, "Would you like to try to work on this?" If she says no, then simply say, "If you ever do, there are some things that can help. Just let me know when you're ready." If she isn't ready, there is no point in pushing her—it won't work. Meanwhile, keep listening, limit junk foods and TV and computer time, and try to set examples of healthy eating and physical activity yourself. These measures should be for all family members, so as not to focus negatively on the overweight child.

But if your child says she is ready, ask her, "Would you like a few ideas about foods that you'll enjoy eating that will help you feel healthier? Would you like to know which foods might be better to try to cut back on?" Assure her that you know she needs to eat, and that she shouldn't have to go without eating when she's hungry. As you begin to help her, continue to make sure that this is her initiative, not yours. A parent might even suggest, "We could find an exercise program for you, if you'd like." Examples are children's fitness programs at the local YMCA or Boy's and Girl's Club. Some children may be more comfortable working on this with a professional rather than with a family member.

If you can help your child discover her own motivation to take on and overcome this challenge, she's far more likely to succeed. Be careful. If she feels that this is your issue and not hers, she'll be at risk of even more overeating—a vicious cycle indeed.

Excerpted from Feeding: The Brazelton Way © 2004 by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Perseus.

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